Long‐Term Efficacy and Outcomes of Endovascular Interventions in Budd‐Chiari Syndrome—A Real World Analysis

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PURPOSE: To evaluate the long-term safety, efficacy, and clinical outcomes of endovascular interventions [hepatic vein/inferior vena cava recanalization and Direct Intrahepatic Portosystemic Shunt (DIPS)] in patients with Budd-Chiari Syndrome (BCS). METHODS: We retrospectively analysed electronic medical records of consecutive BCS patients who underwent endovascular interventions between 2010 and 2022 with at least 2 years of follow-up. We analysed laboratory and clinical parameters, types of interventions, patency rates, and survival outcomes. RESULTS: Of 415 BCS patients, 161 patients underwent endovascular interventions (median age 33.06 (5-75) years, male-to-female ratio 2.2:1). 103 patients who underwent hepatic vein/inferior vena cava recanalization (angioplasty/stenting) and 58 patients who underwent DIPS. The DIPS group had higher baseline median Child-Turcotte-Pugh (CTP) score (8.27), MELD score (14.94) and Rotterdam score (0.96). The recanalization group had baseline CTP score (6.95), MELD score (13.01) and Rotterdam score (0.56). Both interventions resulted in significant improvements in clinical outcomes (ascites resolution and prevention of rebleeding) and ALBI grades (p < 0.01). The DIPS group had persistently higher MELD and ALBI scores (p < 0.05) and required more repeat endovascular interventions (58.6%). The recanalization group required fewer repeat interventions (7.7%). Patency rates at 1 and 5 years were 96% and 92% for recanalization, 82% and 45% for DIPS, and 100% and 60% for DIPS revisions, respectively. The 10-year survival rate was 92% for the recanalization group and 88% for the DIPS group. CONCLUSION: Endovascular interventions provide higher rates of symptom resolution and excellent long-term overall survival in BCS patients. Patients undergoing DIPS exhibited persistently higher severity scores and a higher need for repeat interventions, consistent with a more severe disease phenotype at baseline.

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